Risk, Psychiatry and the Modern Military.

摘要

We are becoming obsessed with risk. The word itself is increasing in epidemic proportions in everything from the mass media to the medical journals. Reducing risk is increasingly the purpose of public health, and indeed politics. Whenever anything is identified as a 'risk', it is inevitable that this is closely followed by calls to remove it. But there remains one section of society whose raison d'etre is to take risks -- the Armed Forces. That is the nature of the military contract. So when men (and increasingly women) go to war, it remains the case, now and then, that some do not come back, some come back physically injured, and some come back with invisible but often equally damaging injuries, the psychiatric. Just as the notion of a military operation that could ever be free of physical casualties is something devoutly to be wished for, but unlikely to be achieved, so it is with psychiatric casualties as well. War provides an exaggerated, perhaps extreme, version of the entire range of human experiences. It is not just fear, hate and guilt, but also excitement, love, friendship and achievement. There is no single 'experience of war', for good or ill. There are some for whom active service remains the best thing that happened to them, and for whom life afterwards became dull and monochromic. But for many, especially those who are not part of modern, professional, volunteer militaries, war was not the best days of their lives, and when they return appear hail in body, but not in mind. It is these experiences that form the first part of this paper.